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Questions and Answers

What is the term for one developmental milestone delay?

  • Developmental assessment
  • Developmental delay (correct)
  • Developmental regression
  • Global delay

    • What is the term used when there are two or more developmental delays?

  • Milestone delay
  • Global delay (correct)
  • Regression
  • Delayed maturation

    • Chronological age for premature infants must be corrected with gestational age until the age of 5.

    False

    At what age does visual acuity typically reach 20/200?

    <p>2 months</p> Signup and view all the answers

    What developmental milestone is typically assessed until school age?

    <p>All developmental milestones</p> Signup and view all the answers

    At what age can a child typically sit alone without separation anxiety?

    <p>3 years</p> Signup and view all the answers

    What is the range of sexual maturation for females?

    <p>8 to 13 years</p> Signup and view all the answers

    When do primitive reflexes typically appear and disappear?

    <p>Appear prenatally, disappear at 6 months</p> Signup and view all the answers

    At what age does the parachute reflex appear?

    <p>1 year</p> Signup and view all the answers

    What is a red flag for developmental delay?

    <p>Global delay, significant delay, developmental regression</p> Signup and view all the answers

    By the age of 1 year, a child should be able to feed from a ____.

    <p>cup</p> Signup and view all the answers

    What number of words is a 3-year-old child typically expected to be able to say in a sentence?

    <p>3 words</p> Signup and view all the answers

    Which virus causes chickenpox?

    <p>Varicella zoster virus</p> Signup and view all the answers

    What is the incubation period for Measles?

    <p>2 weeks</p> Signup and view all the answers

    The primary management for viral infections in children generally includes the use of antibiotics.

    <p>False</p> Signup and view all the answers

    The virus that causes fifth disease is called __________.

    <p>Parvovirus B19</p> Signup and view all the answers

    Rubella typically presents with a bright maculopapular rash.

    <p>False</p> Signup and view all the answers

    What is the management for Varicella in children?

    <p>Acyclovir</p> Signup and view all the answers

    What are the symptoms of Epstein-Barr virus infections?

    <p>All of the above</p> Signup and view all the answers

    What is the incubation period for Cytomegalovirus?

    <p>Up to 4 weeks</p> Signup and view all the answers

    Hospitalized patients with UTI may require __________ if they are unable to take oral medications.

    <p>parenteral antibiotics</p> Signup and view all the answers

    List one common symptom of Otitis media.

    <p>Ear pain</p> Signup and view all the answers

    Match the following infections with their associated viruses:

    <p>Measles = Measles virus Chickenpox = Varicella zoster virus Fifth Disease = Parvovirus B19 Mononucleosis = Epstein-Barr virus</p> Signup and view all the answers

    What is passive immunization?

    <p>Pre-formed antibodies provided to a person for limited immunity.</p> Signup and view all the answers

    What is active immunization?

    <p>A process that stimulates a protective antibody or cell-mediated response in a person.</p> Signup and view all the answers

    Which of the following vaccines are considered live attenuated?

    <p>Measles</p> Signup and view all the answers

    Inactivated vaccines can cause disease even in immunodeficient persons.

    <p>False</p> Signup and view all the answers

    What type of vaccine is not capable of replicating?

    <p>Inactivated Vaccine</p> Signup and view all the answers

    What adverse reaction can occur with the BCG vaccine?

    <p>Superficial irritation, abscess at injection site, and regional lymphadenopathy.</p> Signup and view all the answers

    Which of the following is a temporary contraindication to vaccination with live vaccines?

    <p>Pregnancy</p> Signup and view all the answers

    The oral polio vaccine (OPV) is associated with vaccine-associated paralytic polio (VAPP).

    <p>True</p> Signup and view all the answers

    The hepatitis B vaccine should be given to infants of HBsAg-positive mothers within ______ hours of birth.

    <p>12</p> Signup and view all the answers

    Match the following types of vaccines with their characteristics:

    <p>Live Attenuated = Can replicate in the host and provide long-lasting immunity Inactivated = Cannot replicate and requires multiple doses Subunit = Contains only parts of the pathogen, not capable of causing disease Conjugate = Increases immunogenicity by linking polysaccharides to proteins</p> Signup and view all the answers

    At what age is a child's visual acuity expected to typically reach 200/200?

    <p>3-5 years</p> Signup and view all the answers

    What is a red flag indicating a developmental delay in a child?

    <p>Global delay with more than 2 developmental delays</p> Signup and view all the answers

    What is the expected behavior of a 9-month-old child in terms of sitting position?

    <p>Sits with a straight back and maintains stability</p> Signup and view all the answers

    What should be assessed until school age to ensure appropriate development?

    <p>All developmental milestones</p> Signup and view all the answers

    Which developmental achievement typically occurs by age 1?

    <p>Feeds from a cup</p> Signup and view all the answers

    What cultural factor can influence a child's developmental milestones?

    <p>Cultural norms and practices</p> Signup and view all the answers

    What is the developmental progression pattern in children?

    <p>Cephalocaudal order</p> Signup and view all the answers

    By which age is a child expected to know 50-100 words?

    <p>1 year</p> Signup and view all the answers

    What typically occurs regarding stranger anxiety in infants?

    <p>Peaks at 9 months</p> Signup and view all the answers

    What is a significant developmental concern represented by a significant delay?

    <p>Developmental age significantly different from chronological age</p> Signup and view all the answers

    Study Notes

    Developmental Milestones

    • Developmental delays can be classified as developmental delay (one delay) or global delay (two or more delays).
    • All developmental milestones should be evaluated until school age.
    • Premature infants require their chronological age to be corrected for gestational age until 2-3 years.

    Vision Development

    • Infants show interest in human faces but cannot recognize them until 9 months.
    • Stranger anxiety appears at around 9 months.
    • Vision significantly improves in the first 4 months; visual acuity is 20/200 at 2 months, improving to 200/200 by ages 3-5 years.

    Motor Skills Development

    • Development typically follows a cephalocaudal pattern (from head to toe).
    • At 6 months, infants can sit with an arched back but are unstable, while by 9 months, they can sit upright and stable for extended periods.
    • By 1 year, infants can drink from a cup and exhibit more specific skills, depending on cultural exposure.

    Language Development

    • By 3 years, children should know 50-100 words and can construct sentences matching their age (e.g., 3-year-olds can say 3-word sentences).
    • Toilet training often begins as early as 1 year.

    Red Flags in Development

    • Global delay indicates two or more developmental delays.
    • Significant delay occurs when developmental age and chronological age differ greatly.
    • Developmental regression refers to the loss of previously acquired skills.

    Primitive Reflexes

    • Primitive reflexes are present prenatally and typically disappear by 6 months:
      • Grasp reflex: disappears by 2-3 months
      • Rooting reflex: disappears by 4 months
      • Tonic reflex: appears at 1 month
      • Parachute reflex: appears at 1 year and persists throughout life as a protective mechanism.

    Sexual Maturation

    • The normal range for sexual maturation:
      • Female: 8 to 13 years
      • Male: 9 to 14 years
    • Average onset of first signs:
      • Female: 10.5 years
      • Male: 11.5 years

    Common Pediatric Infections

    Viral Pathogens of Childhood

    • Measles (Rubeola)

      • Incubation Period: 2 weeks
      • Transmission: Direct contact, inhalation of droplets
      • Clinical Features: High fever (>40°C), cough, coryza, conjunctivitis, Koplik spots, maculopapular rash.
      • Management: Symptomatic treatment; MMR vaccine recommended.

    • Mumps

      • Incubation Period: 16-18 days
      • Transmission: Droplets, contact (more common in winter/spring)
      • Clinical Features: Fever, malaise, parotitis (uni- and bilateral)
      • Management: Self-limited; MMR vaccine recommended.

    • Rubella (German Measles)

      • Incubation Period: 2-3 weeks
      • Transmission: Respiratory droplets, transplacental
      • Clinical Features: Maculopapular rash, tender cranial lymphadenopathy, polyarthritis.
      • Management: Symptomatic treatment; MMR vaccine recommended.

    • Varicella (Chickenpox)

      • Incubation Period: 14-16 days
      • Transmission: Contact, airborne droplets
      • Clinical Features: Fever, pruritic macular rash with fluid-filled vesicles.
      • Management: Acyclovir; topical calamine lotion for itching; vaccination recommended.

    • Herpes Zoster (Shingles)

      • Incubation Period: 2-3 weeks
      • Trigger: Reactivation of latent varicella zoster virus
      • Clinical Features: Painful rash, typically localized; burning, throbbing sensations.
      • Management: Acyclovir if treated within 72 hours; supportive care thereafter.

    • Parvovirus B19 (Fifth Disease)

      • Incubation Period: 7-14 days
      • Transmission: Aerosol, blood transplacental
      • Clinical Features: "Slapped-cheek" rash, fever; rash may worsen with sun exposure.
      • Management: NSAIDs, prednisone if needed.

    • Coxsackie A Virus (Hand, Foot, and Mouth Disease)

      • Incubation Period: 1-5 days
      • Transmission: Airborne droplets, fecal-oral
      • Clinical Features: Inflamed oropharynx, vesicles on tongue and mucosa, rash on hands/feet.
      • Management: Supportive care.

    • Epstein-Barr Virus (EBV)

      • Incubation Period: 4-6 weeks
      • Transmission: Bodily fluids
      • Clinical Features: Fatigue, fever, sore throat, generalized lymphadenopathy; risk of splenic rupture.
      • Management: Symptomatic treatment, avoid physical strain.

    • Cytomegalovirus (CMV)

      • Incubation Period: Up to 4 weeks
      • Transmission: Bodily fluids (breast milk, saliva, urine)
      • Clinical Features: Blueberry muffin lesions, hearing loss, seizures.
      • Management: Supportive treatment.

    Other Common Pediatric Infections

    • Otitis Media

      • Common Pathogens: Streptococcus pneumoniae, Nontypeable Haemophilus influenzae, Moraxella catarrhalis
      • Clinical Features: Ear pain, fever, irritability.
      • Management: Oral analgesia, ibuprofen, or acetaminophen; diagnosis via Jones criteria.

    • Impetigo (Bacterial Skin Infection)

      • Common Organisms: Staphylococcus aureus, Group A Streptococcus
      • Clinical Features: Superficial, crusted lesions; highly contagious.
      • Management: Antibacterial wash.

    • Urinary Tract Infections (UTIs)

      • Common Pathogens: E. coli (70-90%), Klebsiella, Proteus
      • Clinical Features: Fever, painful urination.
      • Management: Oral or parenteral antibiotics; parenteral for severely ill patients.

    Prevention Strategies

    • Vaccination is crucial for viral infections (MMR, Varicella).
    • Good hygiene practices to limit transmission (handwashing, avoiding contact during outbreaks).

    Overview of Immunization

    • Immunization is a crucial public health achievement, significantly reducing infectious diseases.
    • It involves the administration of vaccines to stimulate the immune system.

    General Principles of Immunization

    • Passive Immunization:

      • Provides immediate but short-term immunity.
      • Obtained naturally through transplacental maternal antibodies or artificially via immunoglobulin therapy.

    • Active Immunization:

      • Stimulates a long-lasting immune response by introducing an antigen to the host.
      • Acquired naturally through infection or artificially through vaccines.

    Types of Vaccines

    • Live Attenuated Vaccines:

      • Contain weakened organisms, capable of replicating, providing lasting immunity.
      • Examples include measles, mumps, rubella, rotavirus, and BCG.

    • Inactivated (Killed) Vaccines:

      • Made from killed organisms or inactivated toxins.
      • Require multiple doses for effective immunity; examples include IPV and Hepatitis A vaccines.

    • Subunit Vaccines:

      • Comprise purified components of pathogens (e.g., proteins or polysaccharides).
      • Conjugation with protein enhances immunogenicity; examples include Hib and pneumococcal vaccines.

    Routes of Administration

    • Vaccines can be administered via various routes; specific routes depend on the vaccine type and target population.

    Important Vaccines and Their Characteristics

    • BCG Vaccine:

      • Live attenuated vaccine for tuberculosis, effective against TB meningitis and disseminated TB in children.
      • Administered intradermally; potential side effects include irritation and regional lymphadenopathy.

    • Polio Vaccine:

      • Two types: IPV and OPV; OPV linked to rare vaccine-associated paralytic polio (VAPP).

    • DTaP and Tdap:

      • DTaP contains more diphtheria and pertussis antigens than Tdap and is for children under seven.
      • Tdap has reduced diphtheria and acellular pertussis for older children and adults.

    • Hepatitis B Vaccine:

      • Infants of HBsAg-positive mothers require HBIG and HepB vaccine promptly after birth.

    • Pneumococcal Vaccine:

      • PCV13 for primary immunization in infants; PCV23 recommended for high-risk individuals over 2 years.

    • Meningococcal Vaccine:

      • Available as polysaccharide and conjugate vaccines, essential for preventing outbreaks in high-risk areas.

    Contraindications and Precautions

    • Permanent Contraindications:

      • Severe allergic reactions, encephalopathy from pertussis vaccine, or SCID (severe combined immunodeficiency).

    • Temporary Contraindications:

      • Pregnancy and immunosuppression are relative contraindications for live vaccines.

    • Precautions for DTaP:

      • Monitor for high fever, hypotonic episodes, persistent crying, or seizures post-vaccination.

    Timing and Spacing of Vaccines

    • Administration timing matters; non-simultaneous administration may affect immune responses.
    • Antibody presence can interfere with vaccine efficacy; optimize timing for better outcomes.

    Developmental Milestones

    • Developmental delays can be classified as either developmental delay (one milestone) or global delay (two or more delays).
    • All developmental milestones should be assessed until the child reaches school age.
    • For premature infants, chronological age must be adjusted with gestational age until 2-3 years.

    Vision Development

    • Interest in human faces develops, but infants cannot recognize faces until around 9 months.
    • Stranger anxiety typically occurs around the same age.
    • Vision significantly improves within the first four months, starting with visual acuity at 20/200 at 2 months.
    • Visual acuity reaches 200/200 by ages 3-5 years; vision tests usually occur at this age.
    • Development occurs in a cephalocaudal order, meaning it progresses from head to toe.

    Motor Skills and Positioning

    • Sitting milestones at different ages:
      • At 6 months, infants sit with an arched back and can easily fall.
      • At 9 months, infants can sit with a straight back for longer periods, demonstrating stability.
    • By one year, infants can feed themselves using a cup.
    • Cultural differences may impact exposure to certain skills, and it is acceptable if a baby does not demonstrate a specific skill.

    Language Development

    • By 1 year, children typically start to focus on specific words.
    • Vocabulary at age one should range from 50 to 100 words.
    • The number of words in a child's sentences correlates with their age; for example, a 3-year-old can form a 3-word sentence.
    • Language development continues until around age five.

    Other Notable Points

    • Toilet training can begin earlier based on the child's readiness.
    • Red flags for monitoring developmental progress:
      • Global delay indicated by more than two developmental delays.
      • Significant delay marked by a notable difference between developmental age and chronological age.

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